Jeffrey Silver Humanism in Healthcare Research Roundup – January-February 2023

The Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

The association of physician empathy with cancer patient outcomes: A meta-analysis Lelorain S, Gehenne L, Christophe V, Duprez C. Psychooncology. 2023 Jan 24. doi: 10.1002/pon.6108. Epub ahead of print. PMID: 36694295.
Physician empathy has been shown to improve a variety of patient outcomes, particularly in cancer care, but the extent to which PE is associated with outcomes and the mediators of this association remain unclear. Dr. Sophie Lelorain and colleagues examine this through a meta-analysis of 55 articles correlating physician empathy to cancer outcomes. They found that the mean effect size correlation was 0.23, demonstrating a significant association between physician empathy and patient outcomes. However, there was high heterogeneity, with the strongest correlation in studies examining the delivery of bad news and in patients with advanced cancer. In fact, 13 of the 55 (23.6%) had effect size correlations greater than 0.40. The investigators do note the limitations of this meta-analysis, particularly in the difficulties of measuring empathy and disentangling the effects of empathy from kindness and caring. Nevertheless, the authors use these data to conclude that “empathy is not a humanistic fad but a real need for patient health and quality of care.”

Implementation and Assessment of Mentoring and Professionalism in Training (MAP-IT): A humanistic curriculum as a tool to address burnout in surgical residents Kobritz M, Nofi CP, Demyan L, Farno E, Fornari A, Kalyon B, Patel V. J Surg Educ. 2023 Jan;80(1):17-29. doi: 10.1016/j.jsurg.2022.11.002. Epub 2022 Nov 24. PMID: 36437162.  Dr. Alice Fornari has been a Gold Foundation grantee.
Professionalism is one of the core pillars of surgical practice, yet historically, professionalism has been taught largely through role-modeling and other informal activities. At the Northwell-North Shore/LIJ general surgery residency program, Dr. Molly Kobritz and colleagues have sought to formalize its teaching by adapting and implementing a longitudinal training curriculum called Mentoring and Professionalism in Training (MAP-IT). 57 trainees and two faculty facilitators participated in this MAP-IT longitudinal curriculum, in which there were 10 60-minute sessions covering topics such as active role modeling, diversity and inclusion, and mindfulness. To assess MAP-IT’s effectiveness, the investigators used the Connor Davidson Resilience Scale (CD-RISC), the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and Humanistic Teaching Practices Effective Questionnaire (HTPE) two weeks prior to the implementation and two weeks after the final MAP-IT session. They also conducted thematic analysis on transcripts of semi-structured interviews with participants. Among the 38 who completed pre- and post-program surveys, the frequency of burnout declined from 64.1% to 46.1%. Additionally, residents reported lower levels of emotional exhaustion and higher rates of reflection in the approach to the care of the patient and the ability to explicitly teach communication and relationship-building skills. Although the authors note that the lack of a control group and single-center design make it difficult to generalize and extrapolate results, they do conclude by noting that MAP-IT may be an effective intervention to help reduce burnout and improve the quality of humanistic teaching practices.

Gender-based differences in language used by students to describe their noteworthy characteristics in medical student performance evaluations Engel-Rebitzer E, Kogan JR, Heath JK. Acad Med. 2023 Jan 6. Doi: 10.1097/ACM.0000000000005141. Epub ahead of print. PMID: 36606764. Dr. Jennifer R. Kogan has been a Gold Foundation grantee.
The Noteworthy Characteristic (NC) section of the Medical Student Performance Evaluation (MSPE) is an important part of the application for residency selection. It is meant to facilitate holistic review of applications by prompting applicants to highlight their most salient personal and/or professional characteristics. However, there have been concerns about gender differences within this section, given that gender differences have been found in other components of the residency application, such as clerkship evaluation and letters of recommendation. At the University of Pennsylvania Perelman School of Medicine, Dr. Eden Engel-Rebitzer and colleagues examined 783 MSPE’s over four years. They converted NCs into single words and characterized them into five word categories: ability, standout, grindstone, communal, or agentic. They then compared the characteristics between the 371 MSPEs written by women to 410 written by men. After adjustments for underrepresented in medicine status, honor society membership, and intended specialty, men were more likely to use standout or communal words. They were also more likely to discuss scholarship, hobbies, and awards. In contrast, women were more likely to use grindstone words and to highlight community service. The authors caution readers that nuance is needed in interpreting these findings given that gender identity may change and that many inputs go into the NC section. Nevertheless, the authors have identified another set of gender differences in the residency application process that may have real-world impacts on applicant selection.

Evaluation of an intervention in general practices to strengthen social activities in older patients – A qualitative study of patients’ experiences in the project HoPES3 Mächler R, Frick E, Sturm N, Stolz R, Valentini J, Straßner C. Patient Educ Couns. 2023 Feb;107:107571. doi: 10.1016/j.pec.2022.11.013. Epub 2022 Nov 13. PMID: 36436447.
Loneliness, defined as the subjective negative feeling associated with a perceived lack of social networks, is a major problem among elderly people and is a risk factor for worsening physical and mental illness in later life. Dr. Ruth Mächler and colleagues examined this as part of HoPES3 (Holistic care program for elderly patients to integrate spiritual needs, social activity and self-care into disease management in primary care), a complex intervention to encourage social activity among older patients. As part of HoPES3, their team conducted semi-structured interviews with 29 patients over the age of 70. Using Reflexive Thematic Analysis of audio recordings, they found four major themes: (1) Acceptance, (2) Feasibility, (3) Benefits and harms, and (4) Content. Patients reported benefits from talking about loneliness and social relationships. Overall, the authors outlined three takeaways: (1) questions about social relationships should be carefully initiated by primary care clinicians, (2) reasons for loneliness should be investigated so that potential interventions can be individualized, and (3) there should be a low-threshold for providing information about local activities. The authors conclude by emphasizing the need to “focus on long-term evaluations with representative samples and on interventions to connect general practices with local resources and stakeholders in their community.”

The role of social networks in prognostic understanding of older adults with advanced cancer Yu V, Yilmaz S, Freitag J, Loh KP, Kehoe L, Digiovanni G, Bauer J, Sanapala C, Epstein RM, Yousefi-Nooraie R, Mohile S. Patient Educ Couns. 2023 Jan;106:135-141. doi: 10.1016/j.pec.2022.10.009. Epub 2022 Oct 15. PMID: 36270857.
Social networks play major roles in shaping our understanding of healthcare and informing many of the assumptions that underlie medical decisions. This is particularly true in elderly patients who have cancer. Dr. Veronica Yu and colleagues studied the social networks of 16 elderly patients with advanced cancer through in-depth semi-structured interviews, surveys, and social network maps. They then integrated the results of thematic analysis with these social network maps using mixed-methods social network analysis. They found three overarching themes: prognostic understanding (curability and estimated survival), social support (emotional support and in navigating healthcare systems), and therapeutic alliance (the quality of patient-clinician relationships). These themes are strongly influenced by the quality of perceived support from their social networks. Specifically, patients demonstrated better prognostic understanding when they reported close relationships and open communication styles with their network members. The authors concluded by placing these results within their clinical contexts. Namely, clinicians should (1) inform family members of cancer patients on how to be more proactive in providing instrumental and emotional support, and (2) stimulate patients to make use of social networks for instrumental and  emotional support.

A systematic scoping review of reflective writing in medical education Lim JY, Ong SYK, Ng CYH, Chan KLE, Wu SYEA, So WZ, Tey GJC, Lam YX, Gao NLX, Lim YX, Tay RYK, Leong ITY, Rahman NDA, Chiam M, Lim C, Phua GLG, Murugam V, Ong EK, Krishna LKR. BMC Med Educ. 2023 Jan 9;23(1):12. doi: 10.1186/s12909-022-03924-4. PMID: 36624494; PMCID: PMC9830881. Free full text
Reflective practice in medicine is an important aspect of humanistic practice, because it allows physicians to “step back, review their actions, and recognize how their thoughts, feelings, and emotions affect their decision-making, clinical reasoning, and professionalism.” Reflective writing (RW) is a common form of reflective practice at all levels of medical education, but many unanswered questions exist about its effectiveness and role in medical training. To explore this, Dr. Jia Yin Lim and colleagues conduct a Systematic Evidence-Based Approach-guided Systemic Scoping Review. 33,076 abstracts were reviewed, of which 1,826 full-text articles were then appraised. This yielded 199 articles for inclusion and analysis. They found four domains: (1) Theories and models, (2) Current methods of structuring RW programs, (3) Benefits and shortcomings, and (4) Recommendations. Altogether, these suggest that a structured approach to RW shapes the physician’s belief system, guides their practice, and nurtures their professional identity formation. However, further research is needed into assessing the longer-term effects of RW and for understanding the place of portfolios in guiding the career development of physicians.

Social empathy and associated factors among nurses: an observational study Klim G, Boyd KC, Roberts L, Taylor EJ. Holist Nurs Pract. 2023 Jan-Feb 01;37(1):6-14. doi: 10.1097/HNP.0000000000000560. PMID: 36378087.
Social Empathy (SE) refers to “the ability to more deeply understand people by perceiving or experiencing their life situations and as a result gain insight into structural inequalities and disparities.”  Because this construct has only been recently developed, little is known about SE among registered nurses. Dr. Gurun Klim and colleagues examine this through a cross-sectional observational study of 614 registered nurses in a large, non-profit health care system in the northwestern United States. They used the Interpersonal and Social Empathy Index (ISEI), Social Issues Advocacy Scale (SIAS), Self-Compassion Scale-Short Form (SCS-SF), elements of the Maslach Burnout Inventory, and the Trust/Mistrust in Gold Scale to characterize Social Empathy. They found that younger age, higher scores on the SIAS, higher scores on the SCS-SF, less burnout, greater amount of time worked, higher nursing educational level, and current nursing role in management, as a nurse practitioner, or clinical nurse specialist were strong contributors to higher SE. The authors observe that it is unclear exactly how these factors contribute to social empathy and whether social empathy drives these associations or vice-versa. Additionally, the low response rate (17%) makes it difficult to generalize these results. Regardless, this raises important questions about Social Empathy in nurses and clinicians in general and the need for further research.

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.